Method and a system for using implanted medical device data for accessing therapies

RELATED PATENT DOCUMENTS

0001This application claims priority of U.S. application Ser. No. 09/740,127, filed Dec. 18, 2000 now abandoned and U.S. Provisional Application Ser. No. 60/173,062, filed on Dec. 24, 1999 (P-8857), entitled “Chronic Real-Time Information Management Systems for Implantable Medical Devices (IMDs).” The specification and drawings of the Provisional application are specifically incorporated herein in its entirety.

FIELD OF THE INVENTION

0002The present invention generally relates to a method and a system for using implanted medical device data to access medical data processing systems. Specifically, the invention relates to a method and a system for remotely accessing medical data processing systems adapted to provide implanted device therapies in response to patient diagnostic data received from an implanted medical device.

BACKGROUND OF THE INVENTION

0003The present invention is compatible and complementary with the elements disclosed in the following pending applications: “Medical System Having Improved Telemetry,” filed Jul. 19, 1999, Ser. No. 09/356,340; “System and Method for Transferring Information Relating to an Implantable Medical Device to a Remote Location,” filed on Jul. 21, 1999, Ser. No. 09/358,081; “Apparatus and Method for Remote Troubleshooting, Maintenance and Upgrade of Implantable Device Systems,” filed on Oct. 26, 1999, Ser. No. 09/426,741; “Tactile Feedback for Indicating Validity of Communication Link with an Implantable Medical Device,” filed Oct. 29, 1999, Ser. No. 09/430,708; “Apparatus and Method for Automated Invoicing of Medical Device Systems,” filed Oct. 29, 1999, Ser. No. 09/429; “Apparatus and Method for Remote Self-Identification of Components in Medical Device Systems,” filed Oct. 29, 1999, Ser. No. 09/429,956; “Apparatus and Method to Automate Remote Software Updates of Medical Device Systems,” filed Oct. 29, 1999, Ser. No. 09/429,960; “Method and Apparatus to Secure Data Transfer From Medical Device Systems,” filed Nov. 2, 1999, Ser. No 09/431,881 “Implantable Medical Device Programming Apparatus Having An Auxiliary Component Storage Compartment,” filed Nov. 4, 1999, Ser. No. 09/433,477; “Remote Delivery Of Software-Based Training For Implantable Medical Device Systems,” filed Nov. 10, 1999, Ser. No. 09/437,615; “Apparatus and Method for Remote Therapy and Diagnosis in Medical Devices Via Interface Systems,” filed Dec. 14, 1999, Ser. No. 09/460,580; “Virtual Remote Monitor, Alert, Diagnostics and Programming For Implantable Medical Device Systems” filed Dec. 17, 1999, Ser. No. 09/466,284; “Instrumentation and Software for Remote Monitoring and Programming of Implantable Medical Devices (IMDs), filed Dec. 21, 1999, Ser. No. 60/172,937; “application Proxy For Telecommunication-enabled Remote Medical Access Instruments,” filed Dec. 23, 1999, Ser. No. 60/173,081; “Information Network Scheme For Interrogation Of Implantable Medical Devices (IMDs),” filed Dec. 24, 1999, Ser. No. 60/173,064; “Medical Device GUI For Cardiac Electrophysiology Display And Data Communications,” filed Dec. 24, 1999, Ser. No. 60/173,065; “Integrated Software System For Implantable Medical Device Installation And Management,” filed Dec. 24, 1999, Ser. No. 60/173,082; “Dynamic Bandwidth Monitor And Adjuster For Remote Communications With A Medical Device,” filed Dec. 24, 1999, Ser. No. 60/173,083 “Large-Scale Processing Loop For Implantable Medical Devices (IMDs),” filed Dec. 24, 1999, Ser. No. 60/173,079; “Chronic Real-Time Information Management Systems For Implantable Medical Devices (IMDs),” filed Dec. 24, 1999, Ser. No. 60/173,062; “Automatic Voice and Data Recognition For Medical Device Instrument Systems,” filed Dec. 24, 1999, Ser. No. 60/173,071 “Central Switchboard to Facilitate Remote Collaboration With Medical Instruments,” filed Dec. 24, 1999, Ser. No. 60/173,080; which are all incorporated by reference herein in their entireties.

0004A technology-based health care system that fully integrates the technical and social aspects of patient care and therapy should be able to flawlessly connect the patient with care providers irrespective of separation distance or location of the participants. While clinicians will continue to treat patients in accordance with accepted moderm medical practice, developments in communications technology are making it ever more possible to provide medical services in a time and place independent manner.

0005Prior art methods of clinical services are generally limited to in-hospital operations. For example, if a physician needs to review the performance parameters of an implanted device, the patient will likely visit the clinic. If the medical condition of the patient with the implanted device warrants a continuous monitoring or adjustment of the device, the patient will have to stay in the hospital for an extended period of time. Such continuous treatment plans pose both economic and social hardship on patients. Depending on the frequency of data collection this procedure may seriously inconvenience patients that live in rural areas or have limited physical mobility. The need for upgrading the software of an implanted medical device also requires another trip to the hospital to have the upgrade installed. Further, as the segment of the population with implanted medical devices increases many more hospitals, clinics and service personnel will be needed to provide in-hospital care to patients, thus escalating the cost of healthcare.

0006Emergency trips to the hospital or clinic also increase the cost of healthcare due to lack of early detection of heart conditions, such as arrhythmias, that are treatable with less invasive practices such as medicinally, if the condition is detected on a timely basis. As the heart condition worsens, the need for physician intervention and long term hospitalization and medication increases. Current detectors of heart conditions, such as arrhythmia detectors, are available but these devices suffer from the shortcomings of external monitoring devices. The difficulties of patients to educate and inform themselves about medical devices prospectively or devices implanted in them, outside of the confines of the hospital, and to participate in their own clinical care and therapy by learning of the latest developments in this area are additional factors that contribute to the increasing costs of healthcare.

SUMMARY OF THE INVENTION

0007Various embodiments of the present invention are directed to addressing various needs in connection with reducing healthcare costs by facilitating the access of general and specific information on a patient's implanted medical device (IMD), thereby allowing the patient to participate in their own clinical care and therapy. Accordingly, the present invention provides a method and system for facilitating a patient's access to current IMD diagnostic data for timely administration of medical therapies with the assistance of an data processor.

0008In various embodiments the present invention supports a communications system for providing web-based data resources to capture, analyze, format and display patient-specific information on demand and in real-time. In addition, the invention provides an Internet-based secure site to enable a patient to uplink their IMD to transfer data into a data management center where the data is analyzed and relevant therapy/clinical care is dispensed accordingly. Another aspect of the invention pertains to arrhythmia management via a programmable patient arrhythmia notification device in coordination with the patient's IMD. The notification device can also communicate with a web-based remote data management center. In another aspect of the invention, IMD patients have access to a web-based data management system for IMDs for accessing various clinical and therapy alternatives and related information/services.

0009According to one embodiment of the invention, a method and system facilitates the access by a patient of implanted medical device related data for patient participation in clinical care and therapy. The method includes establishing a communications link between an implanted medical device and a data processor via an implanted medical device interface. Access to a secured database is obtained via the implanted device data processor using a set of patient identification data. A query is then submitted via the data processor to the secured database in response to input of patient diagnostic data. Data received from the secured database is then displayed for use in a patient evaluation.

0010According to another embodiment of the invention, a method and system facilitates access by an IMD patient to their own IMD diagnostic data for patient education and evaluation. The method includes establishing a communications link between an implanted medical device and a data processor via an implanted medical device interface. Access to a secured database is obtained via the data processor by using a set of patient identification data. Further, a set of patient diagnostic data from the implanted medical device is then transmitted to the data processor for processing. A set of formatted data is then generated, as a function of a data request from the patient, via the data processor using the patient diagnostic data. The set of formatted data received from the secured database via the data processor is then displayed for use in a patient evaluation regimen as required by the doctor or established medical care.

0011The above summary of the present invention is not intended to describe each illustrated embodiment or every implementation of the present invention. The figures in the detailed description that follow more particularly exemplify these embodiments.

BRIEF DESCRIPTION OF THE DRAWINGS

0012The invention may be more completely understood in consideration of the following detailed description of various embodiments of the invention in connection with the accompanying drawings, in which:

0013<figref idref="DRAWINGS">FIG. 1A</figref> illustrates a block diagram of a system for facilitating the access by an IMD patient to a data processor capable of processing IMD related data in accordance with an example embodiment of the invention;

0014<figref idref="DRAWINGS">FIG. 1B</figref> is a flow diagram illustrating an example manner of implementing therapies in connection with detected heart conditions in accordance with an example embodiment of the invention;

0015<figref idref="DRAWINGS">FIG. 2</figref> is a flow diagram illustrating another manner of accessing IMD diagnostic data and implementing therapies in connection with detected heart conditions in accordance with another example embodiment of the invention; and

0016<figref idref="DRAWINGS">FIG. 3</figref> is a diagram of a system for accessing and processing IMD information as a function of an IMD patient's request in accordance with an example embodiment of the invention.

0017While the invention is amenable to various modifications and alternative forms, specifics thereof have been shown by way of example in the drawings and will be described in detail. It should be understood, however, that the intention is not to limit the invention to the particular embodiments described. On the contrary, the intention is to cover all modifications, equivalents, and alternatives falling within the spirit and scope of the invention as defined by the appended claims.

DETAILED DESCRIPTION

0018The present invention is generally directed to a method and system for generating an IMD related data response as a function of a detected condition in connection with a patient's IMD. While the present invention is not necessarily limited to such an application, the invention will be better appreciated using a discussion of example embodiments in such a specific context.

0019Early patient notification of various heart conditions can empower a patient to take direct action regarding management of the identified heart condition. In the case of arrhythmias, a device guided antiarrhythmic therapy would allow patients to use drug therapy based upon implanted device notification rather than having to seek medical attention for recurring arrhythmic events. One of the capabilities provided by the present invention is that of arrhythmic detection with programmable notification tailored to specific drug therapies. Accurate detection of atrial fibrillation is a component of a properly operating patient notification device and IMD therapy implementation system.

0020In an example embodiment, an external messaging system is provided and adapted to communicate with an IMD and use an alpha-numeric messaging program to instruct the patient when to schedule drug therapy. A configurable treatment process is incorporated into an arrhythmia monitoring and notification system for guiding medication therapy for arrhythmia termination, fast ventricular response, or anticoagulation therapy. The configurable features cooperate with the external messaging circuit to assist in scheduling or rescheduling therapy based on patient action and drug delivery timing. The process also provides closed loop communications between an implantable drug delivery system and an implanted electrical therapy device. The system of the present invention greatly simplifies the patient's role in the decision loop for self-administration of IMD therapies.

0021Referring now to the figures, <figref idref="DRAWINGS">FIG. 1A</figref> illustrates a block diagram of a system <b>100</b> for facilitating the access by a patient to an implanted medical device data processor that is capable of detecting various conditions in accordance with an example embodiment of the invention. System <b>100</b> facilitates the access by a patient to implanted medical device related data for the patient's participation in clinical care and therapy. System <b>100</b>, in this example, includes an IMD port interface <b>104</b> that is coupled to an IMD <b>102</b> via a communications link <b>106</b>. Communications link <b>106</b> is established, in this example, via telemetry when port interface <b>104</b> is in close proximity to the IMD. The link can also be established, for example, with radio frequency signal based telemetry. IMD interface <b>104</b> includes features of a programming head or wand that is incorporated into a programming unit for detecting and transmitting IMD diagnostic data. In another embodiment, IMD interface <b>104</b> includes an IRM (Interactive Remote Monitor) that is used to uplink data from the implanted device to IMD data processor <b>108</b> or to a related website. IMD port interface <b>104</b> is coupled via communications link <b>110</b> to an IMD data processor <b>108</b>, which includes a database <b>109</b>. Communications link <b>110</b> can be established via a telephone, a video conference call, a cellular telephone, via a separate Internet connection or other related communications formats for the transmission of data and voice to IMD data processor <b>108</b>. IMD data processor <b>108</b> is coupled via a communications link <b>111</b> to a communications network <b>112</b>, which includes a server <b>113</b>. Network <b>112</b> is in turn coupled to a data processing center <b>114</b> via a communications link <b>116</b>. The data processing center includes medical personnel that analyze and evaluate diagnostic data received from an IMD. The data processing center may be co-located with the patient or may be located remote from the patient and accessed through communications network <b>112</b>.

0022In this example embodiment, a patient messaging system (PMS) <b>118</b>, co-located with IMD <b>102</b> is coupled to IMD data processor <b>108</b> via IMD interface <b>104</b>. PMS <b>118</b> includes a display <b>119</b> and a circuit adapted to assess and detect heart conditions in conjunction with the IMD. The circuit includes a processor <b>118</b>A and a memory arrangement <b>118</b>B as well as an audio signal arrangement (not shown) for emitting sounds that are audible by a patient having IMD <b>102</b>. A similar circuit is also within data processor <b>108</b> for remote detection of heart conditions. In one example embodiment, PMS <b>118</b> is coupled to IMD <b>102</b> via a telemetry link <b>120</b> and is adapted to access IMD status information and independently alert the patient of a heart condition that requires some form of therapy or treatment. The patient is then advised of the therapy options available for treating the detected condition. In another embodiment, the patient initiates a patient query to determine IMD status. In both embodiments, PMS <b>118</b> generates at least one suggested therapy (medicinal and/or electrical pulse) that is displayed on display <b>119</b> and that is be exercised or administered primarily by the patient. In yet another embodiment, PMS <b>118</b> is also capable of programming or reconfiguring certain program features within IMD <b>102</b>.

0023System <b>100</b> of the present invention provides the capabilities of notifying a patient of an arrhythmia onset and guiding the patient and/or physician to administer the appropriate drug or electrical therapy. By using PMS <b>118</b>, which in this example is an alphanumeric messaging and programmable patient notification device, the patient is guided through various pharmacological and electrical therapies as required. The patient can now critically time the taking of medications to terminate an arrhythmic event or slow down the ventricular rate or use the medication in combination with electrical therapies. The longer the arrhythmia duration, the less successful medications will be in terminating the arrhythmia. In addition, anticoagulation drug therapy may have to be extended for an additional 3-4 weeks to reduce the risk of a stroke to the patient. Notification via PMS <b>118</b>, which is proximate to IMD <b>102</b> (via a wrist worn device or a personal digital assistant type device), is useful in guiding the patient through anticoagulation therapy when events are long lasting and unresponsive to medical and/or electrical therapies. System <b>100</b>, via PMS <b>118</b>, provides the feature of advising the patient in real time of the success or progress of the elected treatment or therapy. Furthermore, since some medications can increase the likelihood that antitachycardia pacing or defibrillation therapies will terminate an arrhythmia, PMS <b>118</b> will guide the patient as to the appropriate time to take certain medication in order for electrical therapies to be more successful.

0024Referring again to <figref idref="DRAWINGS">FIG. 1A</figref>, a communications link is first established between IMD <b>102</b> and IMD data processor <b>108</b> via IMD port interface <b>104</b>. In a related embodiment, the communications link is established directly between the IMD and data processor <b>118</b>A in order to establish two way communications between the patient and PMS <b>118</b> for the patient implemented therapies scenario. Implanted medical device database <b>108</b>, which is a secured database or website provided via IMD data processor <b>108</b>, is then accessed by using a set of patient identification data. In this example embodiment, the patient identification data is the serial number of the IMD but can be a special code that is assigned to the IMD patient for obtaining access to the secured database. System <b>100</b> facilitates access by the patient having IMD <b>102</b> of the secured database using the IMD serial number as the password, after which the patient requests information and/or data from the database. Information available to the patient includes, but is not limited to, information about the particular IMD in use, latest technological developments, clinical trials, patient/lifestyle guidelines, support group information, special HOT LINE numbers for emergencies, dietary and exercise programs and additional links to other websites. System <b>100</b> detects the condition at the IMD patient location that the patient is seeking information or data and proceeds to provide the data as a function of the inquiry made. The data response is then generated by IMD data processor <b>108</b> and displayed (e.g., on a CRT or LCD screen or LED display) for use by the patient in educating himself on current IMD health concerns or issues.

0025In another example embodiment, processor <b>118</b>A communications with the patient is initiated by either the patient or by PMS <b>118</b> where a heart condition is detected. In this example, the patient of IMD <b>102</b> actively seeks a status evaluation of (or a treatment strategy for) his IMD with respect to his heart and either activates PMS <b>118</b> or obtains access to IMD data processor <b>108</b> for an evaluation or detection of at least one of a plurality of current heart conditions. Once the link with the IMD data processor <b>108</b> (or PMS <b>118</b>) is established, patient diagnostic data is uplinked to the IMD data processor (or PMS <b>118</b>) for evaluation and detection of the patient's heart condition. Detectable heart conditions include, but are not limited to, arrhythmia, tachycardia, bradycardia and eventual heart failure and are detected over IMD port interface <b>104</b> for processor <b>108</b> (or directly by <b>118</b>A from the IMD). A data response as a function of the detected heart condition is then generated by IMD data processor <b>108</b> (or PMS <b>118</b>) and is displayed for use in patient evaluation. In an example embodiment, the data response is displayed on display <b>119</b> of PMS <b>118</b> and includes a list of recommended medicinal and/or electrical impulse therapies that are administered by the patient (or a medical assistant).

0026Referring now to <figref idref="DRAWINGS">FIG. 1B</figref>, a flow diagram <b>140</b> illustrates an example manner of processing IMD diagnostic data and implementing therapies in connection with detected heart conditions, in accordance with an example embodiment of the invention. In general, the system guided drug therapy process is illustrated is programmable and is intended to interact and communicate with external messaging systems. In a related embodiment, a patient activator (not shown) communicates with PMS <b>118</b> to properly time electrical therapies with medication therapies. In this example embodiment, at step <b>142</b> atrial fibrillation (AF) is initiated or commences and lasts for a certain duration of time, with the time value exceeding a predefined time value before the patient notification process starts or before the patient notices that a problem may be occurring. At step <b>143</b> PMS <b>118</b> initiates communication with the patient, and depending on the time duration or other defined criteria, will follow either steps <b>144</b>, <b>150</b>, <b>154</b> or <b>158</b>. At step <b>144</b>, PMS <b>118</b> advises patient that AF has exceeded a time value of T<b>1</b> and/or that the Burden has exceeded a certain Burden limit value (B limit) and that it is time to initiate therapy. In this example, the patient is alerted by an alarm signal coming from PMS <b>118</b> and is instructed at step <b>146</b>, via an alphanumeric message on display <b>119</b>, as to his treatment options. In this example, his treatment options include either drugs or pacing options or a combination of both. Two way communications already having been established as discussed earlier, the patient exercises one of the treatment options and advises PMS <b>118</b> of the treatment option exercised. At step <b>148</b>, PMS <b>118</b> notifies the patient whether AF has terminated. If AF has not terminated, the process can loop back to step <b>144</b> or move to another step in process <b>140</b>.

0027At step <b>150</b>, the patient is notified by PMS <b>118</b> that the time duration has exceed a time value of T<b>2</b>, or a burden limit (or any other criteria that is a function of AF duration). At step <b>152</b>, the patient is advised on patient management treatment options, which in this example includes taking anticoagulant medication. The patient again proceeds to exercise one of the treatment options and advises PMS <b>118</b> of the option exercised. As in the example described above, the process moves to step <b>148</b> where the patient waits to be notified that AF has terminated.

0028At step <b>154</b>, PMS <b>118</b> notifies the patient that the ventricular rate metric has exceeded a time value of T<b>3</b>. At step <b>156</b>, the patient is advised on patient management treatment options, which in this example includes taking rate-controlling medication. The patient again proceeds to exercise one of the treatment options and advises PMS <b>118</b> of the option exercised. As in the example described above, the process moves to step <b>148</b> where the patient waits to be notified that AF has terminated.

0029At step <b>158</b>, PMS <b>118</b> notifies the patient that heart failure is beginning due to a prolonged AF condition. In one example, a sensor input that detects heart failure communicates the condition to PMS <b>118</b> in order that the patient is alerted of this condition. At step <b>160</b>, the patient is advised on patient management treatment options, which in this example includes taking medication to control on the onset of heart failure and/or to call his physician immediately. The patient again proceeds to exercise one of the treatment options and advises PMS <b>118</b> of the option exercised. As in the example described above, the process moves to step <b>148</b> where the patient waits to be notified that AF has terminated. In all of the embodiments described, the patient has the choice of taking control of his own therapy with the guidance and regular feedback (via two-way communication) of PMS <b>118</b>.

0030Referring now to <figref idref="DRAWINGS">FIG. 2</figref>, a flow diagram <b>200</b> illustrates another manner of accessing and processing IMD diagnostic data, and implementing therapies in connection with detected heart conditions, in accordance with an example embodiment of the invention. At step <b>202</b>, IMD data processor <b>108</b> (or processor <b>118</b>A of PMS <b>118</b>) detects an atrial fibrillation and the patient is notified by an audible sound emitted by PMS <b>118</b>. In another example embodiment, the audible sound is prompted by a notification signal <b>117</b> sent by IMD data processor <b>108</b> via interface <b>104</b> to PMS <b>118</b>. In this example embodiment, the patient of IMD <b>102</b> is advised of the detection of one of three conditions: patient alert for Atrial fibrillation (AF; step <b>204</b>); patient alert for anticoagulation (step <b>230</b>); and patient alert for rapid and prolonged ventricular rate (step <b>240</b>). Depending on the detected condition, a different path is followed by the IMD patient in administering therapy with the assistance of PMS <b>118</b> and system <b>100</b>. In one example, the patient is notified via PMS <b>118</b> to take a medication <b>206</b> and to advise PMS <b>118</b> when the medication has been taken. At step <b>208</b>, a determination is made whether the AF is still present. If not, at step <b>210</b> the patient is notified that AF is terminated. If so, at step <b>212</b> the patient is advised accordingly and another set of therapy options is communicated to the patient. Depending on the programming of PMS <b>118</b>, antitachycardia pacing will be automatically delivered at an optimal drug rate, which is set by either a fixed time interval or by a change in sensed atrial cycle length (a surrogate of drug effect). At step <b>214</b>, another determination is made whether the AF is still present; if not, at step <b>216</b> the patient is advised accordingly. If so, at step <b>218</b> either automatic pacing continues with a return path to <b>212</b>, or the patient, at step <b>220</b>, activates the defibrillation mode of IMD <b>102</b> and applies a shock to terminate the arrhythmia.

0031In another embodiment, programmable PMS <b>118</b> instructs the patient to perform electrical therapies in order to terminate the arrhythmia. If this approach is not successful PMS <b>118</b> advises the patient to follow another course of action by taking the medication and activating PMS <b>118</b> to repeat the pacing therapies after a fixed time interval or when atrial cycle length changes. Shock therapy may be in order at this point with notification being programmed for a fixed time interval to allow the medication ample time to terminate the heart condition before having to provide the shock treatment. In most of the embodiments, the patient has the option of receiving continuous feedback via PMS <b>118</b> (or other display methods) regarding medication efficacy.

0032Referring to step <b>230</b> of <figref idref="DRAWINGS">FIG. 2</figref>, system <b>100</b> along with PMS <b>118</b> is helpful in assisting in the management of anticoagulation therapy. At step <b>232</b>, the programmable features of PMS <b>118</b> have a burden threshold. For example, if atrial arrhythmia is present for greater than a certain portion of a 24- hour interval, the patient is notified to start anticoagulation therapy and/or see a physician.

0033Referring to step <b>240</b>, system <b>100</b> assists in the management of ventricular rate control for patients with paroxysmal AF. PMS <b>118</b> and system <b>100</b> provide guidance in the use of medication only when needed, since rate controlling medications are poorly tolerated. This treatment strategy greatly improves a patient's quality of life by using the programmable feature of PMS <b>118</b>; at step <b>242</b>, to intermittently use rate control medications. At step <b>244</b>, a determination is made whether the ventricular response is in the alert criteria zone, such as a fast zone. If so, at step <b>246</b> the patient is notified via the alert feature of PMS <b>118</b> that an AF is occurring (ventricular response is in the fast zone) and to start taking the rate control medication. If the ventricular response is not in the criteria zone, at step <b>248</b> the patient is notified that the ventricular response is normal. At step <b>250</b>, another determination is made whether AF is present. If so, at step <b>252</b> patient continues the rate control medication. If AF is not present, at step <b>254</b> the patient is notified that AF has terminated and rate controlling medication therapy is to be terminated. In this example embodiment, for patients with chronic AF with accelerated (or breakthrough) fast ventricular response, PMS <b>118</b> alerts the patient to take an extra dose of rate control medication. If that dose is ineffective, or more than two extra doses are needed within a 24 hour to prevent a fast ventricular response, then the patient is notified to visit a physician.

0034In another embodiment, the antiarrhythmic, anticoagulation and ventricular rate control medication therapies guided by system <b>100</b> are simultaneously implemented. A patient that has an episode of AF is notified to take an antiarrhythmic medication in an attempt to terminate the arrhythmia. PMS <b>118</b> also notifies the patient that the ventricular response is in the fast zone and should also take a rate control medication. If no such therapies are successful and AF burden falls into the anticoagulation zone, the patient is notified to start anticoagulation therapy.

0035PMS <b>118</b> provides instructions to the patient on when medications and electrical therapies should be delivered based upon programmable features. The programmable features complement any device in the system that monitors, detects and notifies patient when an arrhythmia is occurring. Treatment options generated by PMS <b>118</b> include: 1) medications only and not implementing any electrical therapies, such as in the equipment sold under the brand Reveal™; 2) implementing pacing backup for drug-induced bardycardia; 3) implementing pacing backup with antitachycardia (AT500™); or 4) implementing pacing backup, antitachycardia pacing and defibrillation (Jewel AF™). PMS <b>118</b>, in one embodiment, is a handheld device using standard telemetry communications protocols or a wristwatch device using radio frequency signals to establish the telemetry link with the IMD. The patient uses the handheld device upon receiving an audible notification tone (from PMS <b>118</b>) to place the handheld device in close proximity to the IMD or an IPG (implanted pulse generator). The alphanumeric messaging circuit then instructs the patient regarding rhythm status and the type of medication or electrical therapies need to be administered. The patient also uses the handheld device to instruct the IPG as to when a medication was taken in order that electrical therapies are timed to occur at a maximal medication effect. Thus, any synergies between medication and electrical therapies are exploited.

0036Some of the advantages provided by the various embodiments of the present invention include: early recognition of the need for therapy; proper diagnosis and therapy early in the detection process; and reduced risk of toxicity from medications that would normally be taken chronically due to an inability to properly diagnose the heart condition. With the present invention, antiarrhythmic medications are administered when an atrial fibrillation occurs and the patient is not be burdened with the expense, toxicity and inconvenience of daily medication consumption. In addition, quantifying the daily AF burden and ventricular response can guide usage of anticoagulation and rate control drug. Moreover such diagnosis and patient awareness will document drug therapy efficacy on a real time basis. By diagnosing on a timely basis a patient's heart condition, such as an arrhythmia, undesirable consequences such as chronic AF, congestive heart failure or thromboembolic events can be avoided. Continuous monitoring of heart rhythm with patient notification of arrhythmia onset and termination will allow the patient to be in control of their AF management. With improved arrhythmia management provided by the present invention the patient is alerted to take medication, to deliver electrical therapy (pacing or defibrillation) or seek medical attention before onset of conditions requiring anticoagulation therapy.

0037<figref idref="DRAWINGS">FIG. 3</figref> illustrates a system <b>300</b> for accessing and processing IMD patient diagnostic data, as well as formatting such data as a function of the IMD patient's request, in accordance with an example embodiment of the invention. The method and system facilitate the access by an IMD patient of diagnostic data for patient education and evaluation. IMD information is retrievable from and is displayable at a home environment <b>302</b>, for example. Additional information is retrievable through a database located at a data processing center or hospital via the Internet <b>304</b>. Patient information that is retrieved in a healthcare facility <b>306</b>, and stored in a secured database, is accessible by the patient via the Internet <b>304</b> or by telephone or other communication systems.

0038In this example embodiment, the patient first establishes a communications link between the IMD and the IMD data processor <b>108</b> via the IMD device interface as in <figref idref="DRAWINGS">FIG. 1</figref>. A secured IMD database provided by the IMD data processor is then accessed using a set of patient identification data (e.g., IMD serial number or an alpha-numeric password assigned by database manager). A set of patient diagnostic data from IMD <b>102</b> is then transmitted via an uplink transmission to IMD data processor <b>108</b> for processing. A set of formatted data is generated, as a function of a request from the patient, by IMD data processor <b>108</b> using the patient's diagnostic data. In one example, current diagnostic data is compared with the patient's historical information stored in database <b>109</b>. In another example, the data is also formatted to draw comparisons with information from other IMD users to illustrate a trend or for recognition of a pattern in the patient's IMD operation. The formatted data generated by IMD data processor <b>108</b> is then displayed for use in the patient's own evaluation or as an interactive tool to be used with the physician or with a data processing center having staff knowledgeable in implanted medical devices. In another embodiment, the interactive component is available for discussing the patient formatted data with a remotely located expert data center or physician. This can include a voice connection via a home PC or using the telephone to have a discussion concerning the displayed data.

0039As illustrated in <figref idref="DRAWINGS">FIG. 3</figref>, the patient diagnostic data is retrievable from the IMD and certain heart conditions are detectable by IMD data processor <b>108</b> (or PMS <b>118</b>) that include, but are not limited to, Atrial Fibrillation, Ischemia, MI (Myocardial Infarction) and SCD (Sudden Cardiac Death) detection and prediction. Other equipment that can be incorporated into system <b>100</b> for improved diagnostic capability of a patient's IMD condition include: implanted event recorders, implanted diagnostic monitors and pacing/defibrillation systems. Other non-invasive physiological information can also be gathered by system <b>100</b> that would assist the patient in conducting a minimal level of self-health evaluation. For example, ECG information is retrievable for analysis by the patient well before a health condition occurs that requires hospitalization. This information is recorded in the database <b>109</b> for later use in patient diagnostic data analysis and is accessible through server <b>113</b> of communications network <b>112</b> or through the Internet <b>304</b>.

0040Some of the advantages provided by the various embodiments of the present invention include enhanced patient availability for regular IMD and ECG evaluations and a comfortable interrogation session in a patient's home or familiar environment that eliminates the necessity of traveling to the hospital.

0041The present invention is compatible with a number of techniques for interrogating implanted medical devices, such as drug pumps, neurological implants, nerve stimulators, various cardiac implants and equivalent medical devices. In addition, the embodiments described are compatible with remote patient management systems that interact with remote data and expert data centers and compatible with a data communication system that enables the transfer of clinical data from the patient to a remote location for evaluation, analysis, data reposition, and clinical evaluation.

0042Various modifications, equivalent processes, as well as numerous structures to which the present invention may be applicable will be readily apparent to those of skill in the art to which the present invention is directed upon review of the present specification. The claims are intended to cover such modifications and devices.